Eur J Pediatr Surg 2012; 22(06): 415-419
DOI: 10.1055/s-0032-1329711
Review
Georg Thieme Verlag KG Stuttgart · New York

Thoracoscopy versus Thoracotomy for Esophageal Atresia and Tracheoesophageal Fistula Repair: Review of the Literature and Meta-analysis

Francesca Astra Borruto
1  Department of Medical and Surgical Pediatric Sciences, Unit of Pediatric Surgery, University of Messina, Messina, Italy
,
Pietro Impellizzeri
1  Department of Medical and Surgical Pediatric Sciences, Unit of Pediatric Surgery, University of Messina, Messina, Italy
,
Angela Simona Montalto
1  Department of Medical and Surgical Pediatric Sciences, Unit of Pediatric Surgery, University of Messina, Messina, Italy
,
Pietro Antonuccio
1  Department of Medical and Surgical Pediatric Sciences, Unit of Pediatric Surgery, University of Messina, Messina, Italy
,
Emanuela Santacaterina
1  Department of Medical and Surgical Pediatric Sciences, Unit of Pediatric Surgery, University of Messina, Messina, Italy
,
Gianfranco Scalfari
1  Department of Medical and Surgical Pediatric Sciences, Unit of Pediatric Surgery, University of Messina, Messina, Italy
,
Francesco Arena
1  Department of Medical and Surgical Pediatric Sciences, Unit of Pediatric Surgery, University of Messina, Messina, Italy
,
Carmelo Romeo
1  Department of Medical and Surgical Pediatric Sciences, Unit of Pediatric Surgery, University of Messina, Messina, Italy
› Author Affiliations
Further Information

Publication History

29 August 2012

30 August 2012

Publication Date:
21 November 2012 (online)

Abstract

Introduction The thoracoscopic approach to esophageal atresia (EA) with tracheoesophageal fistula (TOF) represents a challenging procedure whose real benefits remains unclear. Our purpose is to identify, through a meta-analysis, clinical evidence of the reliability of the thoracoscopic repair (TR) for EA/TOF compared with the open repair.

Materials and Methods Defined PubMed search, with analysis of intraoperative and postoperative complications after open or thoracoscopic primary anastomosis for EA/TOF.

Results Five articles met the criteria of meta-analysis, being comparative studies between TR and conventional open repair (COR), although they were retrospective. One article was excluded because it was available only in Japanese. We observed a slight prevalence, statistically insignificant, of the intraoperative and postoperative complication rate for TR: odds ratio (OR) 1.29. Excluding the conversion rate, the meta-analysis between the complication rate for TR and COR did not show a significant difference (OR 0.64). Anastomosis's leaks and strictures considered together did not show a significant difference between the two techniques, p = not significant and OR of 0.56. Similar results were observed analyzing the single outcome of leaks and strictures; the meta-analysis did not show any significant differences with an OR, respectively, of 1.05 and 0.43.

Conclusions The effectiveness of the endoscopic technique for EA/TOF repair is indicated with outcomes not different from open surgery. A randomized controlled trial is needed in this field to indicate which procedure is superior, open or TR.